Anhang III 32005R1441

Text von Bild 1 Holder's copy 1. Consignee (name, full address, country, VAT number) 2. Issue number 3. Year 4. Authority responsible for issue (name, address and telephone No) 5. Declarant/representative as applicable (name and full address) 6. Country of origin (and geonomenclature code) 7. Country of consignment (and geonomenclature code) 1 8. Last day of validity 9. Description of goods 10. TARIC code 11. Quantity expressed in quota unit 12. Security/guarantee (as applicable) 13. Further particulars 14. Competent authority's endorsement Date: …………………………………. (Signature) (Stamp) Text von Bild 15. ATTRIBUTIONS Indicate the quantity available in part 1 of column 17 and the quantity attributed in part 2 thereof 16. Net quantity (net mass or other unit of measure stating the unit) 17. In figures 18. In words for the quantity attributed 19. Customs document (form and number) or extract No and date of attribution 20. Name, Member State, stamp and signature of the attributing authority 1. 2. 1. 2. 1. 2. 1. 2. 1. 2. 1. 2. 1. 2. Extension pages to be attached hereto. Einfuhrgenehmigung der Europäischen Gemeinschaft Text von Bild 2 Copy for the issuing authority 1. Consignee (name, full address, country, VAT number) 2. Issue number 3. Year 4. Authority responsible for issue (name, address and telephone No) 5. Declarant/representative as applicable (name and full address) 6. Country of origin (and geonomenclature code) 7. Country of consignment (and geonomenclature code) 2 8. Last day of validity 9. Description of goods 10. TARIC Code 11. Quantity expressed in quota unit 12. Security/guarantee (as applicable) 13. Further particulars 14. Competent authority's endorsement Date: …………………………………. (Signature) (Stamp) Text von Bild 15. ATTRIBUTIONS Indicate the quantity available in part 1 of column 17 and the quantity attributed in part 2 thereof 16. Net quantity (net mass or other unit of measure stating the unit) 17. In figures 18. In words for the quantity attributed 19. Customs document (form and number) or extract No and date of attribution 20. Name, Member State, stamp and signature of the attributing authority 1. 2. 1. 2. 1. 2. 1. 2. 1. 2. 1. 2. 1. 2. Extension pages to be attached hereto.